Net 30 Application Form

We are happy to accept applications for 30-day terms via this form. Please note that unless otherwise indicated, all fields are required. This form is for existing customers only - if you would like to become a customer please fill out our New Customer Form.

BUSINESS INFORMATION
Business Name*
UBI #*
LCB License #*
Applicant Email*
Applicant Phone*
OWNERS/PARTNERS/OFFICERS
Name*
Title*
Name
Title
Name
Title
BANKING
Name of Bank*
Account Number*
Contact Name*
Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Account Type*
ACCOUNT TYPE
- Checking
- Savings
- Loan
Has this business (or any owner, partner, or corporate officer listed on this form, ever filed for bankruptcy?*
Has this business (or any owner, partner, or corporate officer listed on this form, ever filed for bankruptcy?
- Yes
- No
Provide details regarding bankruptcy*
CREDIT REFERENCES
Please do not list Cash-On-Delivery (COD) or Credit Card accounts.
Company*
Contact Name*
Contact Phone*
Contact Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Company*
Contact Name*
Contact Phone*
Contact Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Check this box to add TR3
- Check this box to add another Trade Reference (not required)
Company
Contact Name
Contact Phone
Contact Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
TERMS OF AGREEMENT
In consideration of extension of credit and/or net-30 billing by Confidence Analytics LLC, the applicant agrees, acknowledges, and warranties the following terms:
1. The applicant hereby authorizes Confidence Analytics, LLC to contact the references listed on this form for purposes of assessing the credit and financial standing of the applicant business. The applicant represents and warranties the information provided is true and correct, and attests the applicant business’s financial responsibility, willingness to pay all invoices within 30 days of the date of invoice or as otherwise agreed upon. There will be a 1 % per month interest charge added to all balances not paid within 30 days after due date, both before and after judgment, and continuing each month until paid in full. Applicant acknowledges official invoices will be sent via email and they accept responsibility for providing correct and up to date contact information for the correct party to send invoices over for payment.
2. In the event of default in the payment of any amount due, the applicant business agrees and warranties payment of all outstanding finance charges, reasonable collection costs (including agency, attorney, and court costs/fees) incurred. Venue of any suit shall be laid in King County.
3. The applicant business agrees to notify Confidence Analytics LLC promptly in writing of any changes in ownership conducted under the account name. This Agreement shall be binding upon any successors and assigns of the applicant business regardless of any subsequent incorporation, reorganization, merger, consolidation of the applicant business, change of partners, change of name or any other change in the composition of applicant business. No terms or conditions hereof may be changed except by written consent of Confidence Analytics LLC. Should the applicant fail to notify Confidence Analytics LLC promptly in writing regarding any changes of ownership, Confidence Analytics LLC reserves the right to revoke account terms.
Clickwrap*
- By checking this box, I accept the Terms Of Agreement
Name of Signator*
Title of Signator*
Comments
This field is for validation purposes and should be left unchanged.

Net 30 Application Form

BUSINESS INFORMATION

OWNERS/PARTNERS/OFFICERS

BANKING

CREDIT REFERENCES

TERMS OF AGREEMENT